A randomized controlled trial comparing mupirocin and polysporin triple ointments
in peritoneal dialysis patients: the MP3 Study.
Author(s): McQuillan RF, Chiu E, Nessim S, Lok CE, Roscoe JM, Tam P, Jassal SV.
Affiliation(s): Division of Nephrology, University Health Network, Toronto, Canada.
Publication date & source: 2012, Clin J Am Soc Nephrol. , 7(2):297-303
BACKGROUND AND OBJECTIVES: Infectious complications remain a significant cause of
peritoneal dialysis (PD) technique failure. Topical ointments seem to reduce
peritonitis; however, concerns over resistance have led to a quest for
alternative agents. This study examined the effectiveness of applying topical
Polysporin Triple ointment (P(3)) against mupirocin in a multi-centered,
double-blind, randomized controlled trial.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: PD patients routinely applied
either P(3) or mupirocin ointment to their exit site. Patients were followed for
18 months or until death or catheter removal. The primary study outcome was a
composite endpoint of exit-site infection (ESI), tunnel infection, or
peritonitis.
RESULTS: Seventy-five of 201 randomized patients experienced a primary outcome
event (51 peritonitis episodes, 24 ESIs). No difference was seen in the time to
first event for P(3) (13.2 months; 95% confidence interval, 11.9-14.5) and
mupirocin (14.0 months; 95% confidence interval, 12.7-15.4) (P=0.41). Twice as
many patients reported redness at the exit site in the P(3) group (14 versus 6,
P=0.10). Over the complete study period, a higher rate per year of fungal ESIs
was seen in patients using P(3) (0.07 versus 0.01; P=0.02) with a corresponding
increase in fungal peritonitis (0.04 versus 0.00, respectively; P<0.05).
CONCLUSIONS: This study shows that P(3) is not superior to mupirocin in the
prophylaxis of PD-related infections. Colonization of the exit site with fungal
organisms is of concern and warrants further study. As such, the use of P(3) over
mupirocin is not advocated in the prophylaxis of PD-related infections.
|
